Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
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The Fast-Paced Future of Cell and Gene Therapies
New report on the evolving cell and gene landscape features Avalere Health experts Kylie Stengel and Mark Von Eisenburg.
Copay Caps Could Reduce OOP Costs for Part D Beneficiaries
Analysis shows adding prescription drug copay caps to Part D benefit redesign could reduce OOP costs by 45% per enrollee.
Medicaid Expansion Map
Since passage of the Affordable Care Act (ACA), 39 states and DC have expanded Medicaid. Some of the remaining states may reconsider expansion given new federal funding incentives.
CMS Finalizes Discarded Drug Refund Requirements with Key Changes
The MPFS final rule implements the discarded drug refund requirement for certain single-use physician-administered drugs, presenting risks to manufacturers of these products.
Patient- and Caregiver-Centered Value in Rare Disease Treatment
Traditional health technology assessments fall short in accounting for how therapy addresses the total burden of illness experienced by affected individuals.
Part D Out-of-Pocket Smoothing Policy Raises Implementation Questions
Implementation of the OOP smoothing program will require additional clarity from the Centers for Medicare & Medicaid Services (CMS) on elements that will affect beneficiary experience, access, and overall sustainability of the smoothing program.
Accelerated Approval of Drugs Gives Underserved Beneficiaries Access
A new Avalere analysis shows the Accelerated Approval pathway provides access to underserved Medicare beneficiaries across a range of conditions with unmet needs.
Navigating the Post-PHE Telehealth Policy Landscape
The end of the public health emergency (PHE) raises policy questions around implications for reimbursement, patient access, and operationalization of telehealth service delivery.
Biden Orders HHS to Test Medicare, Medicaid Drug Pricing Models
President Biden’s executive order directs HHS to identify CMMI model options that could lower drug costs and promote access for Medicare and Medicaid enrollees.
How the ESRD Quality Incentive Program Drives Improvement
The ESRD QIP is the first pay-for-performance program that penalizes dialysis facilities for not meeting performance thresholds.
Cell and Gene Therapy: Fundamental Development Questions for Sponsors
Cell and gene therapy (CGT) technology continues to outpace regulatory and reimbursement mechanisms, requiring sponsors to think proactively about development.
COVID-19 Impact: Clinical, Social Risk in Skilled Nursing Facilities
Changes in clinical and social risk among Medicare beneficiaries treated in SNFs at the start of the pandemic reflect challenges facing the healthcare sector during a public health emergency.
SDOH Factors Impact Drug Adherence for Patients with Multiple Myeloma
Avalere found that characteristics of Medicare patients’ place of residence influenced adherence to combination treatment regimens for multiple myeloma.
Fewer Highly Rated MA Plans in 2023 than in 2022
On October 6, CMS published the 2023 star ratings for Medicare Advantage (MA) plans ahead of the start of open enrollment on October 15.
Taking Inventory: Investment Opportunities in Value-Based Care
Avalere analyzes opportunities for investment in the growing $350-billion market for population-level VBC in Medicare.
Medicare Waste Refunds Could Cost Manufacturers Over $210M Annually
Forty-four Part B drugs could be subject to new CMS wastage refund requirements according to an Avalere analysis of Medicare claims.
CMS Requests Input on Payment Policy for New ESRD Therapies
Recent Medicare rulemaking requested stakeholder feedback on potential payment system changes to support access to therapies for patients on dialysis.
Inflation Reduction Act Renews Focus on Value Assessment in the US
Government price-setting provisions in the IRA have highlighted the diverse nature and interpretation of value across the US healthcare system.
Navigating the Road to RSV Prevention
Numerous novel respiratory syncytial virus (RSV) preventive products, including vaccines and monoclonal antibodies (mAbs), are in late-stage clinical development. Consequently, the RSV prevention landscape is expected to transform in the coming years. Adequate preparation to incorporate the use of these new tools should consider the regulatory and recommendation pathways and their implications for coverage and reimbursement.
What Braidwood Management v. Becerra Means for Preventive Services
The court’s ruling could impact $0 cost-sharing coverage of PrEP and other USPSTF-recommended services.